Cost-effectiveness analysis of SARS-CoV-2 infection prevention strategies including pre-endoscopic virus testing and use of high risk personal protective equipment

Ebigbo, Alanna; Römmele, Christoph; Bartenschlager, Christina C.; Temizel, Selin; Kling, Elisabeth; Brunner, Jens O.; Messmann, Helmut

doi:10.1055/a-1294-0427

Cited by 28 publications

(43 citation statements)

References 12 publications

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“…In the clinical setting, all specialties tested their patients before intervention substantially more frequently, with inpatients being tested in over 90% of cases. Despite that, the prevalence of SARS-CoV-2 positive HCW was significantly higher in clinics than private practices, indicating that testing may not play a crucial role at low to moderate incidence levels as discussed by guidelines, [30,31]. In line with that insight, multivariate model revealed no significant association of preinterventional testing with occurrence of the SARS-Cov-2 infection in a medical unit.…”

Section: Discussionmentioning

confidence: 86%

Health-care workers in gastrointestinal endoscopy are at higher risk for SARS-CoV-2 infection compared to other aerosol-generating disciplines

Roemmele

Ebigbo

Kahn

et al. 2021

Preprint

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Objective: Healthcare workers (HCW) are at high risk of SARS-CoV-2 infection due to exposure to potentially infectious material, especially during aerosol-generating procedures (AGP). We aimed to investigate the prevalence of infection among HCW in medical disciplines with AGP. Design: A nationwide questionnaire-based study in in- and outpatient settings was conducted between 12/16/2020 and 01/24/2021. Data on SARS-CoV-2 infections among HCW and potential risk factors were investigated. Results: 2,070 healthcare facilities with 25,113 employees were included in the study. Despite a higher rate of pre-interventional testing, clinics treated three times more confirmed SARS-CoV-2 cases than private practices (28.8% vs. 88.4%, p<0.001). Overall infection rate among HCW accounted for 4.7%. Multivariate analysis revealed that ZIP-regions having comparably higher incidences were significantly associated with increased risk of infection. Furthermore, clinical setting and the GIE specialty have more than double the risk of infection (OR 2.63; 95% CI 2.501-2.817, p<0.01 and OR 2.35; 95% CI 2.245-2.498, p<0.01). The number of procedures performed per day was also significantly associated with an increased risk of infection (OR 1.01; 95% CI 1.007-1.014), p<0.01). No treatment of confirmed SARS-CoV-2 cases was tending to lower the risk of infection (OR 0.72; 95% CI 0.507-1.025, p=0.068). Conclusion: HCW in GIE seem to be at higher risk of infection than those in other AGP, especially in the clinical setting. Regions having comparably higher incidences as well as the number of procedures performed per day were also significantly associated with increased risk of infection.

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Section: Discussionmentioning

confidence: 86%

Health-care workers in gastrointestinal endoscopy are at higher risk for SARS-CoV-2 infection compared to other aerosol-generating disciplines

Roemmele

Ebigbo

Kahn

et al. 2021

Preprint

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“…The majority of recommendations in the position papers are based on expert opinions and early survey-based or observational evidence. Many recommendations are resource-sensitive and may be unavailable in low-resource settings due to issues such as extensive costs, personnel unavailability, lack of sufficient healthcare professional training and logistical limitations [8,11].…”

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confidence: 99%

Resuming endoscopy during COVID-19 pandemic: ESGE, WEO and WGO Joint Cascade Guideline for Resource Limited Settings

et al. 2021

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“…29 A second modeling study concluded that testing is most cost-effective when there is a high prevalence of COVID-19 and high-risk PPE is used. 56 However, this study did not take into account diagnostic accuracy of testing; as the prevalence rises, false positives also increase, which have additional economic downstream consequences, such as quarantining individuals away from work or school unnecessarily. Similarly, this study did not take into account symptom screening as preprocedure protocol.…”

Section: Other Evidence To Decision Considerationsmentioning

confidence: 99%

AGA Rapid Review and Guideline for SARS-CoV2 Testing and Endoscopy Post-Vaccination: 2021 Update

et al. 2021

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This guideline provides updated recommendations on the role of pre-procedure testing for SARS-CoV2 in individuals undergoing endoscopy in the post-vaccination period and replaces the prior guideline from the American Gastroenterological Association (released July 29, 2020). Since the start of the pandemic, our increased understanding of transmission has facilitated the implementation of practices to promote patient and healthcare worker (HCW) safety. Simultaneously, there has been increasing recognition of the potential harm associated with delays in patient care as well as inefficiency of endoscopy units. With widespread vaccination of HCWs and the general population, a re-evaluation of AGA’s prior recommendations was warranted. In order to update the role of pre-procedure testing for SARS-CoV2, the AGA guideline panel reviewed the evidence on (1) prevalence of asymptomatic SARS-CoV2 infections in individuals undergoing endoscopy, (2) patient and HCW risk of infections that may be acquired immediately before, during, or after endoscopy, (3) effectiveness of COVID-19 vaccine in reducing risk of infections and transmission, (4) patient and HCW anxiety, (5) patient delays in care and potential impact on cancer burden, and (6) endoscopy volumes. The panel considered the certainty of the evidence, weighed the benefits and harms of routine pre-procedure testing, and considered burden, equity, and cost using the GRADE framework. Based on very low certainty evidence, the panel made a conditional recommendation against routine pre-procedure testing for SARS-CoV2 in patients scheduled to undergo endoscopy. The panel placed a high value on minimizing additional delays in patient care, acknowledging the reduced endoscopy volumes, downstream impact on delayed cancer diagnoses and burden of testing on patients.

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Cost-effectiveness analysis of SARS-CoV-2 infection prevention strategies including pre-endoscopic virus testing and use of high risk personal protective equipment

Cited by 28 publications

References 12 publications

Health-care workers in gastrointestinal endoscopy are at higher risk for SARS-CoV-2 infection compared to other aerosol-generating disciplines

Health-care workers in gastrointestinal endoscopy are at higher risk for SARS-CoV-2 infection compared to other aerosol-generating disciplines

Resuming endoscopy during COVID-19 pandemic: ESGE, WEO and WGO Joint Cascade Guideline for Resource Limited Settings

AGA Rapid Review and Guideline for SARS-CoV2 Testing and Endoscopy Post-Vaccination: 2021 Update

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